61864 CPT® code: payer coverage and prior authorization31 of 31 payer prior-auth lists that name 61864 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Neighborhood Health Partnership, Rocky Mountain Health Plans, UnitedHealthcare, UnitedHealthcare Community Plan.
61864 appears in 42 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, BlueCross BlueShield of South Carolina, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (0788) | not covered | Nov 19, 2025 | payer document |
| Aetna | Deep Brain Stimulation (0208) | covered if criteria are met | Mar 27, 2026 | payer document |
| Aetna | Eating Disorders (0511) | not covered | Aug 4, 2026 | payer document |
| Aetna | Epilepsy Surgery (0394) | covered if criteria are met (range 61863-61864) | Jun 23, 2026 | payer document |
| Aetna | Epilepsy Surgery (0394) | covered if criteria are met | Jun 23, 2026 | payer document |
| Aetna | Grid Monitoring and Intraoperative Electroencephalography (0289) | listed, no stance (range 61850-61888) | Apr 17, 2026 | payer document |
| Aetna | Headaches: Invasive Procedures (0707) | not covered | Jul 23, 2026 | payer document |
| Aetna | Huntington's Disease (0614) | not covered (range 61863-61864) | Sep 24, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | covered if criteria are met (range 61850-61888) | Jun 19, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 61000-64999) | Jul 1, 2026 | payer document |
| Aetna | Motor Cortex Stimulation (0755) | listed, no stance | Feb 24, 2026 | payer document |
| Aetna | Parkinson's Disease (0307) | covered if criteria are met | Feb 24, 2026 | payer document |
| Aetna | Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479) | listed, no stance (range 61000-64999) | Jul 9, 2026 | payer document |
| Aetna | Spasticity Management (0362) | not covered (range 61863-61864) | May 26, 2026 | payer document |
| Aetna | Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703) | listed, no stance (range 61000-64999) | Nov 24, 2025 | payer document |
| Aetna | Tinnitus Treatments (0406) | not covered | Jul 10, 2026 | payer document |
| Aetna | Tourette's Syndrome (0480) | not covered | Jul 24, 2026 | payer document |
| Anthem | Deep Brain Stimulation and Responsive Neurostimulation (SURG.00026) | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Deep Brain Stimulation | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Responsive Neurostimulation For The Treatment Of Refractory Focal Epilepsy (A.7.01.143) | listed, no stance | payer document | |
| Blue Cross Blue Shield of Massachusetts | Deep Brain Stimulation (473) | listed, no stance | payer document | |
| Blue Cross Blue Shield of Massachusetts | Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy (716) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Auditory Brainstem Implant (CAM 70183) | listed, no stance | Jul 1, 2026 | payer document |
| Capital Blue Cross | Deep Brain Stimulation (MP 1.042) Procedure codes | covered if criteria are met | Jun 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Auditory Brainstem Implant (SUR714.009) | listed, no stance | Oct 1, 2026 | payer document |
| Premera Blue Cross | Deep Brain Stimulation (7.01.609) Page | 5 of 32 | ∞ | listed, no stance | Sep 8, 2026 | payer document |
| Premera Blue Cross | Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy (7.01.143) | listed, no stance | Oct 14, 2026 | payer document |
| Regence | Deep Brain Stimulation (Surgery 84) | listed, no stance | May 1, 2026 | payer document |
| Regence | Responsive Neurostimulation (Surgery 216) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (2026T0321LL) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (CS030.T) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for Idaho Only) (CS030ID.D) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for Indiana Only) (CS030IN.10) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for Kansas Only) (CS030KS.02) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for Kentucky Only) (CS030KY.12) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for Nebraska Only) (CS030NE.T) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for New Jersey Only) (CS030NJ.M) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for New Mexico Only) (CS030NM.C) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for North Carolina Only) (CSNCT0321.07) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for Ohio Only) (CS030OH.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for Pennsylvania Only) (CS030PA.R) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Cortical Stimulation (for Tennessee Only) (CS030TN.Q) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Deep Brain and Responsive Cortical Stimulation (MMP395.02) | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in IN, VT, WA, WY.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.